On August 1st, I went to Baltimore to attend the StartART Nursing Congress. My fellow attendees were primarily nurses who work in reproductive health and IVF clinics. The presenters were MD’s (reproductive endocrinologists), geneticists, and ethicists from Harvard, Stanford, Weill Cornell, Yale, Vanderbilt and other prestigious centers.

Way too many words and stats appeared on their Power Point slides, but I would like to share some highlights, based on common questions from my patients.

Letrazole appears to be more successful than Clomid in women with poly cystic ovaries but not for those with unexplained infertility. Adding Metformin may help pregnancy rates and lower miscarriage rates.

Inositol (a member of the Vitamin B family) can help ovulation. No solid data on whether it increases pregnancy rates.

Weight gain can induce the development of Polycystic Ovaries. This association was seen when college women who were studied after gaining weight after starting college. From the lecture of Dr. Elizabeth Ginzburg, Harvard Medical School

Embryos with evidence of mosaic cells (chromosomally abnormal cells) can become normal babies. However, the higher the percentage of mosaic cells, the more likely there is to be a problem. From the lecture of Marcus Hughes, Clinical Molecular Geneticist

There is a higher miscarriage rate for women who consumed over 4 or 5 drinks per week, during the months leading up to pregnancy.

There is some evidence that Progesterone is helpful in recurrent pregnancy loss.

In the event of a second miscarriage, a woman should try to preserve some of the “products of conception” to have them tested. Dr. Kutteh stated that 95% of the time, the reasons for recurrent pregnancy loss can be determined.

There is NOT good evidence that treating the MTHFR, Protein Z, or Factor V , is at all helpful unless a woman or a lot of her first degree relatives have had a history of blood clots. From the lecture of Dr. William Kutteh, Reproductive Endocrinologist, Vanderbilt University.

What the future may hold:

Making eggs and sperm from a person’s skin cells will probably be possible in 15 to 30 years, or 20 to 40 years, depending on which researcher you talk to. It is already being done successfully in mice. From the lecture of Henry T. Greely, Professor of Law and Genetics, Stanford University.

Cells for genetic testing of embryos will be able to be taken from the culture medium that the embryo is living in rather than the embryo itself, which will be less invasive for the embryo. From the lecture of Marcus Hughes, Clinical Molecular Geneticist.

Stem cells from bone marrow or embryonic stem cells can help women who have a history of a thin endometrial lining. They migrate to the uterus and help it proliferate. From the lecture of Dr.Hugh Taylor, MD, Professor of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine.

If you choose to ask your doctor about this research or any information you find on the internet, remember that one study does not mean that protocols or standard treatments should be changed. Results can change when studies are repeated. In addition to this , not everyone agrees with the interpretation of data from a given study. And know that when medical journalists profile a study or research they extracted from a journal and published in the mainstream media, they sometimes “distill” the information in a way that may be misleading, or incomplete. There are some fine medical journalists out there, but be aware.

I enjoy bringing my patients information about current research and what things may help them in the future. I am hoping to attend the American Society of Reproductive Medicine Conference in October, and will plan to bring you some of the “pearls” from that.

I was disturbed by a recent brochure I received from a medical marketing company targeting Reproductive Endocrinologists. The company offers to help reproductive endocrinologists ”Fight back against aggressive competition, win at digital marketing, make new locations more profitable, increase revenues consistently, and increase your IVF volume”. Fourteen deliverables were mentioned, none of which mentioned attracting patients by providing great care, which many of the RE’s that I know do indeed provide.

As you whole-heartedly seek to have a baby, I am saddened by the idea that you are treated as a commodity to be captured. But with the money that people spend each year on fertility care ( 2 billion dollars) the reality is that many practitioners and professionals have built their careers around your business. In addition to Reproductive Medicine Centers, entities wanting your business include “Attain” type insurance programs, fertility coaches, sperm banks, and yes, acupuncturists.

So to assemble the best team of practitioners, rather than be directed by search engines to slick websites, I have a few suggestions for you.

Many of my patients do indeed cautiously vet the doctors they ultimately choose. Others are understandably overwhelmed by the choices.

Here is my advice on sorting through the myriad of practitioners and services offered:

Educate yourself about a doctor’s work. Many of you know that fertility clinic’s success rates can be checked through the data bank of the Society for Assisted Reproductive Technology ( SART.org) But I think you also probably know that statistics cannot always tell you what you as an individual need to know, and which statistics actually apply to you. The stats on SART cannot always tell you which doctors you will connect with and have confidence in, and receive personalized care.

If you do want to research the methods or protocols a doctor uses, remember that the mountains of information on the internet are truly a force to be tamed. Stay out of the “rabbit holes” of articles that you may think apply to you, but that actually may not. If you find information that you think applies to you, do not hesitate to ask your doctor about it. A good doc will discuss whether the information applies to you without making you feel bad for asking.

If you do spend time researching articles on the internet, stick to sites associated with accredited medical centers and peer reviewed journals. Even those can misstate or endorse medical information that is not solidly proven. A good basic set of questions, answers and fertility information can be found on a site maintained by the American Society for Reproductive Medicine: reproductivefacts.org. I often follow Google word searches with the word NIH.gov, to more quickly access articles in peer reviewed journals. But if you do look at academic sites, be prepared to assume you may not understand all of the information or may misinterpret it.

Assemble your “team” of practitioners based as much on personal references as “stats”. Slick websites and brochures are inanimate marketing tools and in my opinion, are outweighed by the experiences of real people that you might know. Checking for personal references applies to doctors as well as acupuncturists.

Once you have assembled your team, TRUST them. Try not to second guess and check on everything they do. This does not mean that you don’t ask questions about anything at any time. If knowing the “why” of something that is being done or prescribed, will help you relax, do not hold back. If you choose to get second or third opinions if you have not conceived, know that caring docs (as opposed to those who see you as a commodity) are supportive of additional consults. Your doctors want you to have every chance at having a baby. My doctor husband always welcomed the idea of patients getting a second opinion, to make sure he was right or had not missed something.

There are several sites and blogs where people going through fertility treatment can post information on their experiences with fertility doctors. FertilityIQ.com is one of the sites and has well done articles on a variety of topics including how to pick an IVF doctor. However, when looking at rating systems, realize that sometimes a doctor is very skilled and caring, but perhaps was the first person to present information that was difficult to hear. When a doctor may have said that a donor egg or donor sperm will provide the best chance of bringing a baby home soon, this can be very hard to hear even though it may be statistically true. What the doctor may have heard was that a patient has been trying for several years, and is close to empty on money and emotional reserve. So the doctor may have been inspired to present donor options, without really intending to inflict emotional pain that can surface when a patient has not previously considered this option.

In the future, I intend to write about how to determine what alternative and complementary methods may or may not enhance your fertility, and how to evaluate specific types of practitioners.

In the meantime, keep moving forward on your great goal of having a baby.
Jane

Reproductivefacts.org, found on the American Society of Reproductive Medicine websiteFertilityIQ.com, an independent site with Fertility articles and informationSART.org, the site that contains a data bank for fertility clinic success rates.

In May I went on a ten-day bicycling trip through Puglia, Italy. The area is located on the “heal of the boot” and is considered the undiscovered coast of Italy. I biked on narrow rural roads along the Adriatic Sea past miles of two thousand year old olive trees and Roman ruins. I had forgotten how silence, fresh air, and blue skies can reduce stress and inspire creative thoughts.

I did not plan this vacation to escape from my busy practice of acupuncture for infertility. I love my practice and always feel a renewed commitment to my patients when I return from a break. On my travels, I look for new ideas and thoughts I can share with couples seeking acupuncture for infertility. For example, on my trip to Japan I searched all over Kyoto for a Buddhist Temple with a special “chapel” housing a statue of a fertility goddess that women visit to pray for pregnancy and a baby. When I asked permission to enter (only one person at a time is allowed in) the Buddhist monk looked at me quizzically, no doubt wondering if I really thought I could conceive at my age. I did not try to explain in Japanese that I was there on behalf of my acupuncture for infertility patients. Although I am sure Google Translate could have come to the rescue.

Back to Italy and the souvenir thought I brought back for my acupuncture for infertility patients: There were some tough hills to ride up on some days. Normally I walk my bike up in these situations, unconcerned about fellow riders cruising past me. But I was determined to ride up the last hill of the trip—a 6% grade for one solid mile. Before I got to the hill that day, the young Italian tour guide took me aside and said, “I’ve been watching you ride up hills. You attack them. Don’t attack them. Don’t fight them. Just put your bike in low gear and peddle as easily as you need to”. I truly had been pushing myself so hard that I would arrive at the top of even small hills exhausted and not enjoying the ride. So for this last incline I put the bike in the easiest gear possible, breathed slowly, and focused on the blue sky instead of the hill in front of me. I made it.

And then it came to me. Many women that I have the pleasure of helping have had to push SO hard to try to conceive. They have had to fight to get their body to ovulate, fight with insurance companies to cover costs and attack the many emotional potholes on the road to conception.

My patients have heard me describe how in the United Kingdom, medical practitioners do not use the verbage “get pregnant”. Their obstetrical case histories will read that a woman “fell pregnant after three rounds of Clomid”. In French, the phrase for conceiving is “tromber enciente” from the French verb tromber, which means to fall. The imagery of “Getting” verses “Falling” pregnant illustrates the importance of not fighting and attacking the process of trying to conceive. Eastern medicine and acupuncture for infertility encompasses many strategies but one of them is to reduce tension so that our “Qi” or life force can flow and a woman can “fall” pregnant. Yes, conception is basically about sperm meeting the egg, but because conception does not occur reliably, it seems logical to me that that how we “fall pregnant” still involves an element of mystery.

So this is the souvenir thought I have brought back from Italy for my patients. Try to reduce the noise in your life, walk (or ride) in nature. Experiment with riding in the lowest emotional gear possible. Trust the medical team you have chosen, and above all, keep trusting in yourself and your ability to fall pregnant.

Jane Gleeson
Acupuncture for Infertility and Lifestyle Coaching for Conception

In my acupuncture for fertility practice I have been talking with patients for years now about the hormone disruption caused by environmental chemicals, as well as how nutrition affects reproduction. So I was eager to attend the March 5thEnvironment and Reproductive Science Summit 2016 in Dallas and to share what I learned.

This conference was sponsored by the American Society for Reproductive Medicine, The Society for the Study of Reproduction, and the Society of Reproductive Biologists and Technologists. The presenters and the attendees were MD’s who do IVF, as well as accomplished researchers in the area of reproductive biology and technology.

I thought that I might be the only practitioner who does acupuncture for infertility at the conference, but I was delighted to see MD and mentor, Dr. Sadhna Singh, who was trained in Obstetrics and Gynecology, and practices acupuncture for fertility in Houston , Texas.

I knew that I would return with more questions than answers, and with frustration that many of the findings cannot yet be clinically applied. Indeed, much of the research has not been published yet. But the direction of the data definitely supports the dreadful fact that as a species our fertility may be declining and we are possibly headed toward the need for more assisted reproduction. Attending the conference also validated my efforts for the last twelve years at educating my patients in regard to limiting exposure to endocrine disrupting chemicals.

Researchers from Harvard, UCLA, UCSF, etc., and the National Institute of Health presented information on male and female fertility that was gathered from original research in humans and animals, as well as from surveys and retrospective studies. The focus for all of the studies was Environmental, Nutritional, and Genetic Factors Affecting Reproduction. The endocrine disrupting chemicals, or EDC’s that were discussed included those that come from plastics, pesticides, polluted air, and personal care items.

Scientific “pearls” and notable information included:

Components of plastics are “covalently unstable” which means they do indeed leach out of items and enter the human body.

Some endocrine disruptors such as the fungicide vinclozolin causes “Transgenerational epimutations”. This means that the negative affects of the fungicide are passed on to at least three generations of offspring.

Phthlates, used to soften plastics, caused a decrease in sperm and genital malformations in mice.

Information from surveys included a presentation from a researcher at the National Institute of Health who profiled the ENDO, Life Study and the Oxford Conception Study which show a connection between stress and fertility. It is important to remember that showing an association is not the same as showing cause and effect.

In an effort to present balanced information, I must tell you that not everyone in the scientific community believes that there is enough evidence to supporting a clear connection between exposure to environmental chemicals and endocrine disruption that impairs fertility. But better safe than sorry, and if we cannot eliminate all of the exposure around us, why not limit our exposure as best we can? Drink, cook, eat, and store in glass and stainless steel. Use lotions, potions and personal care products that do not have endocrine disrupting chemicals in them. Reach for the baking soda and vinegar for cleaning. I have shared with all of you that have come to my office for fertility acupuncture, the literature from the UCLA Center for Reproductive Health and the Environment. Their pamphlet will give you information on finding products without potentially dangerous chemicals in them.

The speaker I truly wanted to hear was Dr. Jorge Chavarro, from Harvard. He is an MD and a nutrition researcher, and I have lent many of you the book he wrote with Dr. Walter Willet, The Fertility Diet. He presented data on the association between high pesticide exposure and low sperm count and plastic exposure and low birth weight. But finally there was some good news (and things we can do) from a presenter: Omega-3 fats from fish result in higher sperm counts and higher mono-fat intake (olive, peanut, almond, sunflower, safflower oil, avocados) is associated with higher birth rates. He did add that he was disturbed by one of his recent findings: evil “transfats”, aka, partially hydrogenated fats can still be found in men’s sperm even though it has been largely eliminated in the food supply.

Attendees asked many hard questions of the presenters, such as does the IVF process expose embryos to potentially harmful chemicals, and if so, what is the affect ? Of course you can imagine that the answer was a big fat “We don’t know”. However some researchers are looking at epigenetic, chromotin, and mitochondrial dysfunction (things related to gene function) in regard to the IVF process. If all this seems alarming or confusing, remember that it is a good thing that these issues are being looked at, because it ultimately may be a step to improving the process, safety, and outcomes of IVF. And the bottom line is that every year I get amazingly beautiful Christmas card photos of perfect, beautiful babies.

If any of you would like to talk with me about the conference, do not hesitate to call or e-mail.

Allomothering is a phenomenon observed in animals, particularly monkeys, elephants, and birds. “Allo” is a Greek pre-fix meaning “other” and allomothering refers to nurturing behaviors performed by adults who are not the mothers of the infant they are helping, and are acting as “other mothers”. Allomothering includes such behaviors as carrying, touching, nursing, and protecting. These activities are performed by males and females. Animal scientists believe these helpful activities give a respite to the mother, help the infant mature faster, learn valuable social skills, and pass on important mothering skills to the infant.

I have the pleasure of knowing so many wonderful “alloparents’ who as aunts, uncles, or good friends have enriched the lives of the children they know.

I was very pleased in September to become a clinical instructor for the Medical College of Wisconsin. This position involves mentoring first year Internal Medicine residents who are doing a Womens’ Health rotation at the Milwaukee Veterans’ Hospital. The residents spend time in my clinic, and have the opportunity to learn about the Eastern approach to womens’ health. Many of my patients are seeking acupuncture for infertility, so it has been my role to explain to couples how and why acupuncture can help with infertility. Since many people ask their doctors about whether acupuncture might be helpful for infertility and other womens’ health issues, bravo for the Medical College of Wisconsin for giving residents the opportunity to learn about complementary medicine.

When I meet with a woman seeking acupuncture for infertility, I emphasize the importance of including her spouse or male partner in our two hour session. This is because in addition to information about acupuncture and infertility, I share a lot of information about nutrition and how the nutritional status of both the man and the woman affects fertility and the health of the baby.

Scientific studies have shown that the offspring of male mice who were fed low nutrition diets had more neurological, developmental, and psychological disorders than the control group who were fed a more nutritious diet.

Human studies on pre-conception and pre-natal nutrition are equally interesting. Although it has been shown that a women’s lack of folate (B9) may be responsible for brain and spinal cord defects in a baby, research indicates that a man’s lack of folate can result in passing on damaged DNA and RNA via his sperm. “We should be looking carefully at the way a man is living his life”, said study author and reproductive biologist Sarah Kimmins of McGill University.” “Environmental exposure is remembered in the developing sperm and transmitted to offspring.”

Other things in a man’s life, such as high fat and stress, have also been shown to possibly affect fertility and the health of a child.

Sharing information on some of these issues has been rewarding in my acupuncture and infertility practice, as I see so many women who feel that because they “carried” the baby, they are solely responsible for any miscarriages or defects.

We all know of people with unhealthy lifestyles who break all the rules and become pregnant anyway. This is because conception, like birth, is complex and miraculous. In my acupuncture practice I try to help couples struggling with infertility to embrace this fact and just keep going forward, not trying to achieve perfection, but doing the best they can.

I was intrigued and excited for my acupuncture and infertility patients when I read Dr. Jean Twenge’s article, “How Long Can You Wait To Have a Baby?” in the July issue of the AtlanticMagazine.

Dr. Twenge, who is a Phd. in Psychology at San Diego State University who dealt with “baby panic” in her thirties, states that, “The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying….is based on an article published in 2004 in the journal of Human Reproduction. Rarely mentioned is the source of the data:French birth records from 1670 to 1830. The chance of remaining childless–30 percent–was also calculated on historical populations”. Twenge goes on to say that she could not get a citation (source) from the American Society of Reproductive Medicine’s for their published guidelines that state only 20 percent of 30 year old women and 5 percent of 40 year old women will get pregnant each cycle.

More optimistic research she highlights was done by Dr. David Dunson of Duke Uiversity and published in Obstetrics and Gynecology (2004). It showed tat in 770 European women who had sex at least twice per week, 82 percent of 35 to 39 year olds conceived within a year, compared with 86 percent of 27 to 24 year olds. In a recent Danish study published in Fertility and Sterility, “…among women having sex during their fertile time, 78 percent of 35 to 40 year olds became pregnant within a year, compared to 84 percent of 20 to 34 year olds”. I did wonder if averaging 35 year olds with 40 year olds is misleading, but that gets back to what can be done with statistics. Dr. Twenge goes on to say that Dunson’s research reveals that if couples in their late thirties time intercourse more closely to ovulation, their chances of conception are the same as couples in their late 20’s who seem to have a longer window of fertility each month.

The statistics Twenge reports are very positive and helpful to me as I try to support couples who are trying to conceive naturally or through IVF. However, the fact remains that fertility does decline with age, and the number of eggs a women can produce through IVF at a later age is often reduced. Fortunately , the biomedical options for women in this situation, such as egg and embryo preservation, continue to expand and improve.

Last weekend I attended the Mayo Clinic Complementary and Alternative Medicine Conference. Along with about 29 other major medical centers that include Harvard, Yale, Duke, Cleveland Clinic and Georgetown, Mayo has a department dedicated to Integrative Medicine. A broad range of topics were presented at the conference including Integrative Medicine for Women’s Health, chronic pain, headaches and weight loss. There were sessions on acupuncture, Taiji, Qigong, and Laughter, as well as updates on nutritional supplements and hormone replacement . Although I would like to share all of the conference information with you, I have put just a few facts in the “We already kind of knew that but it’s nice to be reminded category and a“Really? category. The goal of the Mayo physicians was to present e research based information.

“We already kind of knew that” category:

1. Acupuncture has been shown to decrease dysmenorrhoea.

2. Tai Chi improves balance and decreases falls in the elderly.

3. Flaxseed and fish oil lower triglycerides.

4. Probiotics can positively impact gut health

5. The Mediterranean Diet (olive oil, whole grains, fruits and vegetables) can result in a 75% less chance of death over the first 5 years after a myocardial infarction.

“Really?” category:

1. Metformin (a type II diabetes drug) “results in vitamin B12 deficiency in 30% of patients.” This was of interest to me because many of my infertility patients with PCOS symptoms have been put on metformin by their physicians.

2. 90% of women have inadequate intake of folate and vitamin E from food. This has important implications for women in their reproductive years, as it has been well established that folate and its cousin folic acid are key players in healthy formation of the spinal cord in babies.

3. 73% of women do not eat more than three servings of vegetables per day. Five to seven servings of fruits and vegetables (combined) is considered essential to obtain needed nutrients. My opinion is that women struggling with infertility or who are already pregnant need even more.

4. 55% of people do not tell their physicians what supplements they are taking.

5. Patients electing to have “food allergy testing” should know that most of the companies doing expensive testing look at the blood “Igg” response which is not definitive. Measuring “Ige” response is more accurate. Dr. Larry Bergstrom from the Mayo Clinic said people should simple eat a food, “and see how it makes them feel”.

6. In a study done with Topirimate vs. Yoga for migraines, more patients improved with Yoga. Their anxiety and depression scores improved more also.

7. Laughter makes our bodies relax and the effects can last up to 45 minutes.

Although these “take aways” seem to cover many different topics, the conference was indeed broad in scope. As always, I will be discussing more information from the conference with each of my patients, as indicated.

I have written in the past about how I am continually amazed at all of the events in the human body that must occur in a definite sequence in a definite window of time for conception to take place. When a patient has done all of the appropriate tracking of fertile mucus, temperature, LH surges, etc. and combined that with the most important part–intercourse, I am at a loss to explain to them why another month will go by without a positive test. After seeing how a patients cycles have become regular and normal in every way (including proper luteal phase) after coming to acupuncture, I am often frustrated and disappointed right along with my patients.

Although the timing of intercourse does indeed need to be synchronized with ovulation, I am intrigued by some scientific evidence that men’s semen may indeed contain a hormone or chemical that encourages ovulation and helps regulate a woman’s cycles. So for women with irregular or anovulatory cycles, it may be good to have relations throughout the month, as opposed to waiting for fertility signs. This can also be a more relaxed approach to becoming pregnant, which could be good for a relationship.

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